Rapid Intracranial Response to Osimertinib in a Patient with Epidermal Growth Factor Receptor T790M-Positive Adenocarcinoma of the Lung

Reichegger, Hermann; Jochum, Wolfram; Förbs, Diana; Hader, Claudia; Früh, Martin

doi:10.1159/000446759

Cited by 18 publications

(12 citation statements)

References 10 publications

(10 reference statements)

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“…There are currently limited data on the effectiveness of osimertinib alone for patients with progressing brain metastases. Some case reports have demonstrated that the clinical responses achieved on osimertinib may obviate the need for whole‐brain radiation in some patients . The phase I BLOOM study studied the effects of osimertinib 160 mg daily on 20 patients with advanced NSCLC who had progressed on prior EGFR TKIs and had confirmed leptomeningeal disease by cerebrospinal fluid cytology, but the study did not focus on parenchymal metastases .…”

Section: Discussionmentioning

confidence: 99%

Osimertinib for EGFR-Mutant Lung Cancer with Brain Metastases: Results from a Single-Center Retrospective Study

et al. 2018

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Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor recently approved for the first-line treatment of -mutant non-small cell lung cancer. Although it appears to have central nervous system (CNS) activity, most clinical trials have excluded patients with untreated, progressing brain metastases. This study included patients with stable and progressing CNS metastases treated with osimertinib and found no apparent differences in median time to treatment failure, time to progression, and overall survival in patients who received osimertinib alone compared with those who received osimertinib and radiosurgery. This may support a clinician's decision to defer radiation for selected patients with untreated brain metastases who are candidates for osimertinib therapy.

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Section: Discussionmentioning

confidence: 99%

Osimertinib for EGFR-Mutant Lung Cancer with Brain Metastases: Results from a Single-Center Retrospective Study

et al. 2018

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“…For the 2017 update (Version 4), the NCCN panel now also recommends osimertinib (category 1) for patients with T790M who have brain metastases. 37,[164][165][166] Data suggest that an afatinib/cetuximab regimen may be useful for patients whose disease has progressed after receiving EGFR TKI therapy and chemotherapy. 238 Patients with T790M-positive and T790M-negative tumors had a similar response rate to an afatinib/cetuximab regimen (32% vs 25%; P=.341).…”

Section: Second-line and Beyond (Subsequent) Systemic Therapymentioning

confidence: 99%

Non–Small Cell Lung Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Ettinger¹,

Wood²,

Aisner³

et al. 2017

J Natl Compr Canc Netw

1,110

1,005

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“…This PFS benefit was true even for the over 30% of patients with asymptomatic BrM at enrollment with a hazard ratio of 0.32 [53••]. Intracranial response has also been reported in patients with BrM as well as patients with leptomeningeal disease [54–56]. For patients with T790M, either primary or secondary, we favor the use of osimertinib for the use of EGFRact+ BrM.…”

Section: Systemic Therapymentioning

confidence: 93%

A Neuro-oncologist’s Perspective on Management of Brain Metastases in Patients with EGFR Mutant Non-small Cell Lung Cancer

McGranahan

Nagpal

2017

Curr. Treat. Options in Oncol.

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Opinion statementManagement of non-small cell lung cancer (NSCLC) with brain metastasis (BrM) has been revolutionized by identification of molecular subsets that have targetable oncogenes. Historically, survival for NSCLC with symptomatic BrM was weeks to months. Now, many patients are surviving years with limited data to guide treatment decisions. Tumors with activating mutations in epidermal growth factor receptor (EGFRact+) have a higher incidence of BrM, but a longer overall survival. The high response rate of both systemic and BrM EGFRact+ NSCLC to tyrosine kinase inhibitors (TKIs) has led to the rapid incorporation of new therapies but is outpacing evidence-based decisions for BrM in NSCLC. While whole brain radiation therapy (WBRT) was the foundation of management of BrM, extended survival raises concerns for the subacute and late effects radiotherapy. We favor the use of TKIs and delaying the use of WBRT when able. At inevitable disease progression, we consider alternative dosing schedules to increase CNS penetration (such as pulse dosing of erlotinib) or advance to next generation TKI if available. We utilize local control options of surgery or stereotactic radiosurgery (SRS) for symptomatic accessible lesions based on size and edema. At progression despite available TKIs, we use pemetrexed-based platinum doublet chemotherapy or immunotherapy if the tumor has high expression of PDL-1. We reserve the use of WBRT for patients with more than 10 BrM and progression despite TKI and conventional chemotherapy, if performance status is appropriate.

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Rapid Intracranial Response to Osimertinib in a Patient with Epidermal Growth Factor Receptor T790M-Positive Adenocarcinoma of the Lung

Cited by 18 publications

References 10 publications

Osimertinib for EGFR-Mutant Lung Cancer with Brain Metastases: Results from a Single-Center Retrospective Study

Osimertinib for EGFR-Mutant Lung Cancer with Brain Metastases: Results from a Single-Center Retrospective Study

Non–Small Cell Lung Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

A Neuro-oncologist’s Perspective on Management of Brain Metastases in Patients with EGFR Mutant Non-small Cell Lung Cancer

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